5. evidence based practice

Question 1

what’s the problem with the way research and therapy is conducted today?

there are 2 main problems, there’s one general premise

Answer 1

1. research takes a nomothetic approach (lab setting)
2. therapy is idiographic

general assumption that since tx works in sample, will work in gen pop

Question 2

what is evidence based practice?

Answer 2

encompasses empirically supported tx but not equivalent
the 3 legged stool

Question 3

what are the 3 legs of evidence based practice?

Answer 3

1. best evidence from research
2. clinical expertise
3. patient preferences

Question 4

3 legs of EBP

what’s the best scientific evidence?

Answer 4

results from experiments and quantitative studies

Question 5

3 legs of EBP

what is clinical expertise?

3 elements

Answer 5

competence attained by psychologists through education, training, experience, that result in effective tx
* expert panels
* practice groups
* consensus statements

Question 6

3 legs of EBP

what’s patient preference?

4 elements

Answer 6

• satisfaction
• QUALITY OF LIFE
• tx burden
• qualitative studies

Question 7

what are the 6 levels of research evidence

it’s a pyramid!

Answer 7

1. meta-analyses + systematic reviews
2. RCTs
3. cohort studies
4. case-control studies
5. case series, case reports
6. editorials, expert opinion

Question 8

what is efficacy?

Answer 8

performance of an intervention under ideal and controlled circumstances

maximizing internal validity, ruling out confounds

Question 9

what is effectiveness?

Answer 9

how well the tx works among gen pop

generalizability

Question 10

leg 1: research evidence

what are the sources of evidence of the first leg?

3

Answer 10

• efficacy
• effectiveness
• basic psychological processes relevant to tx

Question 11

what are some issues with effectiveness when studying therapies in clinical settings?

there are 5 i can think of

Answer 11

• academic settings are usually sterile
• possible allegiance effect
• administered by people who designed the study
• highly trained therapists with advanced degrees
• voluntary bias: types of people who volunteer to do these experiments aren’t representatitve of gen pop

limits generalizability of findings

Question 12

what is dissemination research?

Answer 12

research that focuses on tx effectiveness testing in real world settings

Question 13

what are some considerations that must be taken into account when researching therapy txs?

there are 5 i can think of

Answer 13

1. patient diversity
2. mode of delivery
3. feasibility of delivery irl
4. tx costs
5. therapeutic relationships

Question 14

what are the 2 most frequent modes of delivery of therapy?

Answer 14

individual and group

Question 15

what is the most frequent patient pool in therapy experiments?

Answer 15

WEIRD – white/western, educated, industrialized, rich, democratic

Question 16

what are some things that are important for clinicians to be able to do to successfully perform tx?

there are 8, but you can name like 6 ig idk

Answer 16

1. clinical case conceptualization (gathering info to put pieces together)
2. tx planning (important to talk to client about it)
3. tx implementation
4. interpersonal expertise
5. self-reflection
6. knowledge + use of research literature
7. understanding influence of diversity + culture on tx (how tx affects diff clientele)
8. seeking consultation + resources

Question 17

when planning a tx, what’s the first thing that’s important to do?

Answer 17

start with research evidence

Question 18

what happens if there’s no research evidence to dictate what to do in a therapy session?

Answer 18

make use of clinical judgement + past experience

Question 19

some questions when evaluating a tx for each pt

5

Answer 19

1. what works for whom
2. research can examine patient moderators of tx effects
3. do tx generalize to minorities?
4. how are comorbidities affected in effectiveness of tx?
5. phenotypically similar sx can have diff etiological + maintenance factors

Question 20

what kinds of social and cultural moderators can affect tx?

Answer 20

sex, gender, race, ethnicity, etc

Question 21

“phenotypically similar sx can have diff etiological + maintenance factors” cool! what does this mean?

Answer 21

even if 2 people have the same dx or comorbidities, doesn’t mean that dx manifests itself in the same way, even if ongoing factors are the same

Question 22

2 advantages of evidence based practice

Answer 22

1. improve quality + cost effectiveness of tx
2. enhance accountability

Question 23

2 criticisms of evidence based practice

Answer 23

1. tx amenable to research more likely to be included (RCTs cheaper and shorter)
2. inappropriately restrict access to certain tx (healthcare might only pay x amount)

Question 24

mechanistic research

3 requirements for clear relationship between guiding theoretical base and tx outcome

Answer 24

1. proposed mechanisms of change should be validated in basic research (why will this tx work to get this outcome? what will account for change?)
2. proposed mechanisms of change should be related to proposed mechanisms for disorder
3. change in proposed mechanisms should relate to change in sx in tx studies

Question 25

what’s an unvalidated tx?

Answer 25

not yet examined sufficiently in a controlled study – not listed as evidence-based, but doesn’t mean that might not work

insurance might not cover yet

Question 25

what’s an invalidated tx?

Answer 25

shown not to work